the HAES® files: Death Threats, Death Anxiety, and Dying While Fat

by Health At Every Size® Blog

by Deb Burgard, PhD

Masters, Ryan, et al., (2013). “The Impact of Obesity on US Mortality Levels: The Importance of Age and Cohort Factors in Population Estimates.”  American Journal of Public Health, published online ahead of print August 15, 2013: e1-e7. DOI:10.2105/AJPH.2013.301379

“Oh yippee, a new research study to re-ignite the debate over fatness and mortality.” Said no fat person, ever.

Now we get to see another round of appeals for our prevention, in order to prevent our early demise, although presumably our early deaths would prevent the predicted economic disaster of our failing to die. Um, what was it again that we wanted to prevent?

Researcher Masters may be tipping his hand with his opening line in a companion paper published earlier this year: “There is now ample evidence and widespread agreement that a massive epidemic of obesity has spread across the United States.” Overstating consensus and the size of the “problem” both serve the interests of the study’s funder, the Robert Wood Johnson Foundation.  In both papers the author is clearly arguing against “framing the obesity epidemic as a ‘moral panic'” [shoutout to Campos, Saguy, Ernsberger, Oliver, & Gaesser, 2005!] and instead insists that “major public health consequences will track with the epidemic and . . . efforts to stem its growth are probably well worth the investment.” So this is about preventing premature death of funding?

Masters’ central argument seems to be that even though the repeated findings for decades of rigorous research (reviewed by Flegal, 2013) has found that BMI and mortality are only weakly correlated, and that higher BMI may actually correlate with longevity in old age, this set of findings must be wrong, because 1) fat elderly people are more likely to be unable to participate in the surveys due to being “institutionalized” more than thin elderly people (no citation), and 2) there are apparently going to be major differences in longevity between people who were fat in their 60’s in 1995 and people who will be fat in their 60’s in 2030 because of the latter group’s “longer exposure to the obesogenic environment.” I guess that is an interesting thought experiment, but if you look at current trends it would seem that fat people are more likely to be healthier in the future if we continue to improve access to healthcare and continue the progress in managing hypertension and diabetes.

I do not pretend to understand the complex equations and “controls” the author performed to arrive at his neat trick of flipping the graphs showing the percentage of deaths attributable to obesity growing rather than diminishing over the lifespan. While the computations left me bewildered, what I found striking was the amount of dismayed language about the prospect of “not investing” in anti-obesity programs:

“the obesity epidemic is worthy of its status as a leading public health concern,”

“the cohort dimension of the obesity epidemic will likely carry forward the health and mortality implications of the epidemic for many years to come,”

“it is imperative for . . those who construct policy . .to recognize that . . more than a century of steady gains in life expectancy are being jeopardized by the obesity epidemic.”

Whatever the details turn out to be in this specific analysis, I think we need to think about the big picture. Every time someone comes up with a “years lost to obesity” or “obesity kills” claim, they have to be comparing it to something. When researchers say that x% of Black women are dying prematurely due to obesity, they are comparing fat and thin Black women, presumably, and that conveniently takes the focus off of all the health disparities from poverty, sexism, violence, racism, stigma, etc., that all Black women face. Look at how low Masters’ rate of death-attributable-to-obesity is for Black men – that’s not because Black men are living so long in “obesity-free” bodies, it’s because so many Black men are killed or die young from all the other assaults they face all their lives so that by the time we consider obesity it is at the end of a long line of much clearer causes of early death.

These sorts of claims make the structural threats to the health of people of color invisible. Why are efforts to police the weight of the bodies of people of color  getting so much more traction, and yes, funding, than efforts to address racism, poverty, unequal access to education and healthcare, the school-to-prison pipeline, wage discrimination, unequal sentencing, death penalty decisions, etc.?

And of course the other big problem is the suggestion that we have some set of decisions, some “policies,” that will prevent weight diversity.  The weight cycling industry is licking its chops over the expansion of markets into communities of color, and even if it were absolutely clear that higher BMI caused earlier death, pursuing weight loss and whipping up anti-obesity hysteria is not a solution, it’s a corporate windfall.

We need a national discussion about death threats, death anxiety, and dying while fat.  Fat people are the target of so much of the cultural baggage around our collective frozen denial about the actual life cycle of humans that I believe it is in itself a risk factor for our health. Every study like this is an invitation to participate in the illusion that we have evidence for a right way of eating or a right kind of body to prevent death.  Most of us have been told by a healthcare provider, “Well you may be healthy now but at some point you are going to get sick and die.”  Right. And your point is? The Boomers are at their peak of social power and death anxiety right now, and I don’t think it’s an accident that we are beset with so much magical thinking around the mortality horizon coming into view.  And magical thinking is fertile ground for selling us stuff, all kinds of stuff to prevent whatever we find terrifying.

What I find terrifying is the way my body gets reduced to a formula in the eyes of people who have the power to help or hurt me. My body is not a number.  It is not a cautionary tale, a ticking timebomb, or a battleground for corporate adversaries trying to make money on marketing to fat people (weight cycling industry! workplace wellness programs! Big Pharma!) or trying to save money by hoping fat people die  (health insurers! HMOs! Cost-of-obesity policy wonks!).

My death will not be a point for one side or the other.  I am opting out of the illusion of immortality as a solution to this terror of not being seen. Instead, I am going to struggle to be seen, and still know that I will die anyway. I am going to live as well and as long as I can, and then I have to get off the bus. It is not different for any of us, and the best use of my time is to make this world a place that gives every one of us the maximum chance at happiness and well-being. My body allows me to do that work for now, and I am grateful for every day.

References:

Flegal, KM et al. (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA Jan 2;309(1):71-82. DOI: 10.1001/jama.2012.113905.
Masters, Ryan, et al., (2013). “Obesity and US Mortality Risk Over the Adult Life Course.” American Journal of Epidemiology,178 (2): 320. 
DOI: 10.1093/aje/kws325
Masters, Ryan, et al., (2013). “The Impact of Obesity on US Mortality Levels: The Importance of Age and Cohort Factors in Population Estimates.”  American Journal of Public Health, published online ahead of print August 15, 2013: e1-e7. DOI:10.2105/AJPH.2013.301379

23 Responses to “the HAES® files: Death Threats, Death Anxiety, and Dying While Fat”

  1. What I find interesting about the life expectancy argument is that I read an article some years back (I believe in Skeptic magazine) about how life expectancy really hasn’t increased in the past century. When you account for the number of premature deaths caused by things that are no longer an issue today for developed nations (like TB, cholera, etc) the life expectancy has really not increased in a way that is statistically significant. So the argument that the “obesity epidemic” will “undo” those “gains” is really ridiculous because there are no actual gains in life expectancy.

  2. This is so important–thank you.

  3. Brilliant essay! One thing that I have noticed is that sometimes those who are willing to admit that Flegal is right, and that the “obesity paradox” of many fat people living longer than many thin people might be correct, they fall back on the argument that there are “quality of life” issues and you can’t possibly have a good life while “obese”. That would call for another line of research, figuring out how to measure people’s relative misery, and comparing miserable fat people to miserable thin people. But people who talk about the “quality of life” issues that might affect fat people more than thin people, never seem to focus on the things that we could do to improve the quality life other than by weight loss. Reducing the stigma of fat would be a good place to start, and all the other obstacles that society places in the way of very large or very small people. Accepting diversity as a worthwhile aspect of humanity (and other species) would be another great goal. But until there is money to be made doing that, you won’t see a big push by powerful interests (like the Robert Wood Johnson Foundation) to help make it happen. That’s why what we do in the size-acceptance and pro-HAES® communities is so important, even when it seems like a David-and-Goliath situation.

  4. “…if you look at current trends it would seem that fat people are more likely to be healthier in the future if we continue to improve access to healthcare and continue the progress in managing hypertension and diabetes…”

    The way the “Body Police” deal with this idea of societal responsibility is to shake their fists at fat people and call us “a burden.” [rolleyes] No other life practice or physical condition burdens the system, don’t you know… Only that jiggly spare tire around my waist.

    I got so sick of this type of nonsense on one of the “progressive/social justice”-type boards last week that I bailed. Yeah, I should be made of stronger stuff and keep fighting the good fight like you all do, but frankly I just couldn’t take it anymore. 😦

    • “Fighting the good fight” for a long time can take the starch out of anyone–to keep our sanity, it helps to bail now and then like you did. I avoid reading the more negative stuff (I have to be in a certain mood to do it), and it is better to spend as much time as possible exposing yourself to more positive stuff–like the writing in this blog! That way, you can renew your energy for carrying on in defense of size diversity. Every storage battery must be recharged. 🙂

      • Thanks, Bill.

        I must confess that I’ve resisted for years the idea that there was genuine bigotry against fat people. I knew that people would behave badly towards other based solely on appearance. I knew that institutions are needlessly cruel towards fat people, but… I was afraid that by actually calling it bigotry I’d be trivializing the other, more commonly-acknowledged kinds: Sexisim, racisim, homophobia, Anti-Semitism, and so on.

        But after seeing the way some of the people in this other space reacted to any image of an overweight person: If that person was seen doing something positive, their body size was not mentioned. But if that person was seen doing something negative, suddenly it was all about fat as both cause and unassailable proof of some kind of all-encompassing evil living inside the wrongdoer… [sigh] Well, I really don’t know how I can call that anything but bigotry from here on in.

  5. Deb, thank you for this brilliant analysis. I cannot express how useful it will be in addressing the obesity hysteria that is bound to follow the publication of this “study.” I will be using the points you make and quoting from it wholesale in the coming months, I suspect!

  6. P.S., lots of brilliantly written and quotable lines, but this was my favorite, “The weight cycling industry is licking its chops over the expansion of markets into communities of color, and even if it were absolutely clear that higher BMI caused earlier death, pursuing weight loss and whipping up anti-obesity hysteria is not a solution, it’s a corporate windfall.”

  7. Wonderfully written essay. Kudos. I remember reading an obituary in the NY Times about a 102 yo woman who reportedly died of obesity. How old do you have to be to simply and peacefully “get off the bus”. Thanks Deb.

  8. Thanks, Deb, for this thoughtful and scientific response. I like the positive and empowering last paragraph.

  9. I have baffled many a physician over my “in the normal range” bloodwork over the years…A few years ago, after tallying an estimated 400lbs of weight lost (and subsequently regained) over the course of forty years, I just got fed up and decided to stop dieting. It is a very scary process, this letting go, but with it comes a feeling of freedom coming from the very essence of my being…I will continue to live the very best life I can, making healthful (but not obssessive) choice. Wish me luck! Oh, and I told my doc to leave me the heck alone about my weight…and he agreed! There is hope for him, after all… 😉

  10. This just lit me on FIRE! I want to share it with the whole world. Thank you for making clear lines that connect the dots and for making it interesting reading! I knew I was going to become a ‘ blog groupie’ when I saw you present at BEDA 2013, but I didn’t know you’d become a hero too 🙂 Terrific!

  11. I love the whole “it will catch up to you eventually” mentality. I’ve had so many people say that throughout my life because, quite frankly, I’ve been considered “morbidly obese” since I was a very young child. By the time I was 7 years old I was wearing adult sizes. By the time I was 12 I was wearing adult plus sizes.The doctors are always so surprised at how healthy I am. Even if I just come in to get some cold medicine they INSIST on running a whole bunch of blood tests and they always come back healthy. Then I get the lecture from the doctor about “well, you’re healthy now, but it will catch up to you. It’s not healthy to carry around so much extra weight. You need to lose weight”. Despite the fact I’ve been eating a mainly vegetarian diet for years, I exercise regularly, I take care of my body, and I’m healthy, it doesn’t matter to these people. They see a fat body and they label me “morbidly obese” and tell me that even though I’ve been living as “morbidly obese” for 30 years it will catch up to me and it will eventually kill me. I look at my lovely and awesome grandmother who has been obese for over 50 years and she’s one of the healthiest people in my family and she’s been told the same thing. People tell her “It will eventually catch up to you”. But she’s in awesome health, obese for over 50 years, and gets to hear the same bullshit. She will eventually get sick, like humans do, and it breaks my heart that no mater what she ends up getting sick with it will almost undoubtedly be chalked up to her “obesity”. Everyone dies, but a thin person and a fat person dying of the exact same illness, the fat person will be put down on the records as dying “because of their weight”. No mater what she eventually gets sick with, it will likely be blamed on her weight.

  12. I love what you’re saying. As I get older (now in my 60s) I worry that I will develop some health condition as a result of (a) getting older, and (b) not having died of anything else yet, and this will be regarded as an occasion for all the health pundits who’ve been warning me that my “obesity” is going to kill me to say, “Nah-nah-I-told-you-so!”

    Perhaps more chillingly, I worry that I won’t be seen as “worthy” of any treatment for whatever health conditions associated with aging that I might develop, because I’ll be seen as “deserving it” because I “didn’t take care of myself” (i.e., somehow make myself thin) during the first 6 decades of my life.

  13. @ Deb…Thank you with your helpful info/analysis of the funding for losing weight but not for all the stress factors that lead most directly to fat Black women’s demise and quality of life AND that Black men are so thin, just dead to early. See me as Sally in “When Harry Met Sally,” screaming “Yes! Yes!” What a great analysis. @ At Xeno who talks about weight stigma as though it’s separate from racism, sexism, homophobia, let us remember that it ISN’T it’s another layer of oppression. A fat White man still have race and gender privilege that isn’t erased with the fat stigma but a fat Black woman suffers from race, gender and weight oppression. Peace.

  14. First, thanks for the mention of racism and its corollaries, something usually left out when discussing the health status of people of color.

    Second, “collective frozen denial about the actual life cycle of humans” is brilliant. How can one live if one is in perpetual fear of death, something that will come to all of us? Sometimes I really think that people of a certain class believe they will not die if they just eat their low-fat diet and go to the gym frequently enough; it’s rather sad.

  15. I’m unfortunately not healthy – I have a genetic condition which affects my connective tissue and joints (Ehlers-Danlos Syndrome). EDS has nothing whatsoever to do with my weight but when I have injuries to my joints, and end up with a stick or in a chair, people (including doctors) tell me I need to “do something about my weight”.

    Last time my doctor said this, I asked him [sarcastically] if losing weight would cure EDS. “No,” he admitted, “but if you were very heavy it would put too much pressure on your knees”. Given that the last time I had trouble with my knees, I was a UK size 10, I’m not convinced.

    Fact is, the best advice for people like me is to keep moving as much as you can, weight-bear as much as you can (I’m now walking normally) and keep your muscle-tone as good as possible. Every single ‘diet’ going reduces muscle mass – I didn’t realise that for years – no wonder I’ve had problems!

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